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Medicare-Medicaid Coordination for Dual Eligibles: What’s it All About?

Monday, May 13, 2013

Over nine million Americans receive benefits from both Medicare and Medicaid costing over $315 billion in health care services in the two programs combined. The dual eligibles account for 15 percent of the Medicaid population and almost 40 percent of all Medicaid expenditures for medical services; and 20 percent of the enrollees in Medicare, but 30 percent of the expenditures.

Who are the dual eligibles? How does the Patient Protection and Affordable Care Act (ACA) address cost and quality of health care issues for this population? What is the office of duals? What federal initiatives are helping to improve quality, integrate care and align financing? How are the states involved in serving dual eligibles? In improving their care and coping with the high cost of care? What do the demos hope to show?A distinguished panel of experts addressed these and related questions.

Michelle Herman, Center for Healthcare Strategies, provided an overview of the dually eligible population and the major ACA provisions addressing their health care needs.

Medicare and Medicaid pay for different services for those who qualify for both programs, which incentivizes cost shifting, Michelle Herman Soper of the Center for Healthcare Strategies said at a May 13 Alliance briefing, "Medicare-Medicaid Coordination for Dual Eligibles: What's it All About?" (Photo by James Ryder)

In Ohio, dual eligibles are 14 percent of Medicaid patients, but account for 34 percent of costs, Greg Moody of the state's Office of Health Transformation said at a May 13 Alliance briefing, "Medicare-Medicaid Coordination of Dual Eligibles: What's it All About?" Ohio is planning to launch a demo project in the fall to try and lower costs by coordinating care of duals. (Photo by James Ryder)

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